Understanding ‘embedded pharmaceuticalisation’: A case study of sleeping medication use in later life

Sleeping medication use in later life is linked to adverse effects including falls, cognitive decline and dependency. Despite guidelines advocating reduced prescribing and sociological findings of ambivalence and unease among older adults, long-term use remains prevalent. This paper explores how and why sleeping medication use persists in later life, drawing on interviews and diaries with 38 UK adults (65+), whose average use spanned 17 years. While participants expressed familiar moral concerns around use, these were outweighed by a profound emotional need for sleep and reliance on what they saw as the sole effective remedy. We conceptualise this enduring use as 'embedded pharmaceuticalisation': a process through which sleeping medication becomes woven into emotional life, personal identity and daily behaviours. Participants' use was sustained with active strategies (e.g. sourcing, stockpiling) and passive ones (e.g. avoiding reviews), reflecting forms of consumer agency rooted in fear, habit and necessity, rather than optimisation. While much sociological work has focused on the initiation or moral framing of pharmaceutical use, less attention has been paid to the trajectories through which medication comes to be viewed not only as normal, but as necessary. Attending to different forms of pharmaceuticalisation, such as embedded, helps illuminate tensions between expressed desires to reduce or avoid medication and continued long-term use.